The candidate is a pediatrician, epidemiologist, and an applied informatics fellow with the National Library of Medicine. His primary career objective is to improve the quality of urban pediatric primary care using computer-based technologies such as the electronic medical record (EMR). Using resources available in Boston through the Boston University School of Medicine, the Neighborhood Health Center Healthnet Collaboration, and the National Initiative for Child Healthcare Quality, he proposes to spend three years evaluating strategies to improve the quality of pediatric health care using EMR technologies. His focus will be in two areas of central importance to the primary care clinician-preventive services and the care of asthma. The specific aims of this project are to use a common EMR in a network of urban primary care centers to: 1) describe the content and quality of EMR-based urban child and adolescent primary care; 2) evaluate the efficacy of evidence-enhanced audit and feedback to improve the delivery of multiple primary care services (preventive services and asthma care); 3) describe the perceptions of primary care clinicians and quality improvement strategies used following receipt of practice-based audit and feedback; 4) evaluate incremental improvements in quality following the addition of point-of-care decision support to improve the delivery of multiple primary care services (preventive services and asthma care); and 5) describe the perceptions of primary care clinicians following receipt of point-of-care decision support. These studies build on the candidate's six years of experience in the development and evaluation of pediatric EMR software. The long-term career objectives are to lead a collaborative research network in the City of Boston that will develop, use, and evaluate technology-based solutions (including the EMR) to improve the health and healthcare of urban children.